Diet and physical activity in multiple sclerosis: associations with quality of life and disability by disease duration.
Nag N, Yu M, et al. • Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology • 2026
Physical activity is associated with higher quality of life and lower disability irrespective of MS duration and should be integrated across the disease course, whereas associations of diet, supplements and wellness activities with QoL may be modified by MS duration.
Key Findings
Methods
Associations between lifestyle factors and QoL/disability were examined in a cross-sectional sample of 1,083 people with MS, split by time since diagnosis (≤5 years vs >5 years).
Data were self-reported survey responses from 1,083 pwMS.
Diet, supplement use, and wellness activities were queried via tick-box options and recategorised.
Physical activity was assessed with the Godin-Shephard Leisure-Time Physical Activity Questionnaire; QoL with Neuro-QoL; ambulatory disability with Patient Determined Disease Steps.
Analyses used multivariable linear regression and moderation analyses.
Results
Physical activity was associated with higher QoL in both disease-duration groups, with mostly stronger associations in those diagnosed ≤5 years.
Associations with higher QoL were observed in both the ≤5-year and >5-year groups.
The associations were mostly stronger within the ≤5-years group.
Results
Very active physical activity was associated with lower ambulatory disability across both duration groups.
Disability was measured with the Patient Determined Disease Steps.
The association held in both the ≤5-year and >5-year groups.
Results
A low-saturated fat diet and 'other' diets were associated with lower QoL in the >5-years group.
The associations differed by MS duration.
These diet associations with lower QoL were observed in the >5-years group rather than the ≤5-years group.
The cross-sectional design means this may reflect people with worse QoL adopting such diets.
Results
Omega-3 supplement use was associated with higher physical QoL in the ≤5-years group.
The association was specific to the group diagnosed within ≤5 years.
The outcome was physical QoL measured with Neuro-QoL.
Results
Mind-based wellness activities were associated with lower QoL in the >5-years group, with no significant group differences.
The association with lower QoL was observed in the >5-years group.
Moderation analysis showed no differences between duration groups.
Results
Vitamin D supplement use was not associated with QoL or disability outcomes.
No associations were found with the study outcomes.
Conclusions
MS duration may modify associations between some lifestyle factors and QoL, suggesting disease stage should be considered when tailoring lifestyle recommendations.
Diet, supplement, and wellness associations varied by duration group, whereas physical activity associations were consistent.
Authors conclude physical activity should be integrated across the disease course.
What This Means
This study surveyed 1,083 people with multiple sclerosis (MS) about their diet, supplements, wellness activities such as mind-based practices, and exercise. It then compared these with their quality of life and walking-related disability, separately for people diagnosed within the last 5 years and those diagnosed longer ago.
The clearest result was for physical activity: more activity was linked with better quality of life in both groups, and very active people had less walking disability. The link to quality of life was mostly stronger in the recently diagnosed. Other factors differed by time since diagnosis. In people with MS for more than 5 years, low-saturated-fat and other diets and mind-based wellness activities were linked with lower quality of life, while omega-3 supplements were linked with better physical quality of life in the recently diagnosed. Vitamin D supplements showed no link with either outcome.
Because this was a one-time survey, it cannot show that any of these habits cause better or worse outcomes; for example, people who feel worse may choose certain diets or practices. This research suggests physical activity is beneficial-looking at all stages of MS, and that the stage of disease may be worth considering when thinking about other lifestyle approaches.
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Nag N, Yu M, Román C, Vaglio-Garro A, Schmidt H. (2026). Diet and physical activity in multiple sclerosis: associations with quality of life and disability by disease duration.. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. https://doi.org/10.1007/s10072-026-09352-2